呼吸重症监护室产质粒介导AmpC酶和ESBLs细菌的耐药性及基因型
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陆 坚

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R969.3

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广东省自然科学基金项目(5009113)2008年深圳市福田区公益性科研项目(FTWS048)


Antimicrobial resistance and genotypies of  plasmidmediated AmpC βlactamasesproducing and extendedspectrum βlactamasesproducing strains in  respiratory intensive care units
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    摘要:

    目的了解深圳地区2所三级综合医院呼吸重症监护室(RICU)分离的革兰阴性(G-)菌产AmpC酶和超广谱β内酰胺酶(ESBLs)情况及其耐药性与基因型特征。方法选择分离自上述2所医院RICU的对第一、二代及1种以上第三代头孢菌素耐药的大肠埃希菌和肺炎克雷伯菌,采用纸片扩散法及Etest进行药敏试验,酶提取物三维试验检测单产AmpC酶,美国临床实验室标准化研究所 (CLSI)推荐的表型筛选和确证试验检测产ESBLs菌株,聚合酶链反应(PCR)通用引物扩增AmpC酶和ESBLs基因及其序列测定以确定基因亚型。结果检出单产AmpC酶、单产ESBLs、合产AmpC酶和ESBLs的菌株分别为9株(9.38%)、52株(54.17%)和10株(10.42%)。单产AmpC酶菌株对头孢吡肟和亚胺培南具有较高的敏感性,耐药率分别为33.33%和0.00%;单产ESBLs菌株对亚胺培南、哌拉西林/他唑巴坦及头孢哌酮/舒巴坦的敏感性较高,耐药率分别为0.00%、34.62%和19.23%;合产AmpC酶和ESBLs的菌株仅对亚胺培南敏感,未发现耐药株。检出AmpC酶基因型为DHA1和ACT1,分别占76.92%和26.08%;ESBLs基因型为CTXM系列和SHV5,分别占96.77%和3.23%。结论该2所综合医院RICU存在产质粒介导DHA1、ACT1型AmpC酶和CTXM、SHV型ESBLs的G-菌流行株,其对大多数新型广谱β内酰胺类抗生素耐药,对亚胺培南敏感,值得临床关注。

    Abstract:

    ObjectiveTo investigate antimicrobial resistance,genotypies and the prevalence of AmpC βlactamasesproducing and extendedspectrum βlactamases (ESBLs)producing gramnegative strains from specimens of respiratory intensive care units(RICUs) in 2 hospitals of Shenzhen.MethodsA total of 96 multidrugresistant Escherichia coli and Klebsiella pneumoniae strains were detected by threedimensional test for AmpC βlactamases and phenotypic confirmatory test based on Clinical and Laboratory Standard Institute (CLSI) criteria for ESBLs.Antimicrobial susceptibility of AmpC βlactamases and ESBLsproducing strains was detected by KirbyBauer and Etest methods.Universal primer PCR for AmpC βlactamases and ESBLs gene amplification and DNA sequencing were carried out for genotyping of these βlactamases.ResultsAmpC βlactamases, ESBLs and AmpC βlactamases combined with ESBLsproducing strains were found in 9(9.38%), 52(54.17%)and 10 (10.42%) strains,respectively.AmpC βlactamases producing strains were more susceptible to cefepime and imipenem, the resistant rate being 33.33% and 0.00% respectively. ESBLsproducing strains were more susceptible to imipenem,piperacillin/tazobactam and cefoperazone/sulbactam , the resistant rate being 0.00%, 34.62% and 19.23% respectively. AmpC βlactamases combined with ESBLsproducing strains were only sensitive to imipenem and no imipenemresistant one was found. The genotypes of AmpC βlactamases were DHA1and ACT1, the incidence being 76.92% and 26.08% respectively. ESBLs genotypes were CTXM series and SHV5, the incidence being 96.77% and 3.23% respectively.ConclusionThere are epidemic strains of plasmidmediated DHA1,ACT1 type AmpC βlactamases and CTXM,SHV type ESBLsproducing gramnegative strains in RICUs in two hospitals, they are resistant to  most  new broadspectrum βlactam antibiotics, but sensitive to imipenem.

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姚丽英,李国保,李沛,等.呼吸重症监护室产质粒介导AmpC酶和ESBLs细菌的耐药性及基因型[J]. 中国感染控制杂志,2011,10(2):92-96.
YAO Liying, LI Guobao, LI Pei, et al. Antimicrobial resistance and genotypies of  plasmidmediated AmpC βlactamasesproducing and extendedspectrum βlactamasesproducing strains in  respiratory intensive care units[J]. Chin J Infect Control, 2011,10(2):92-96.

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  • 收稿日期:2010-02-08
  • 最后修改日期:2010-05-22
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  • 在线发布日期: 2011-03-30
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